Form 4768 - Application For Extension Of Time To File A Return And/or Pay U.s. Estate (And Generation-Skipping Transfer) Taxes Page 2

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2
Form 4768 (Rev. 8-2012)
Page
Decedent’s first name and middle initial
Decedent’s last name
Decedent’s social security number
Part V
Notice to Applicant—To be completed by the Internal Revenue Service
Note. If applying for an extension of time to pay, file this page in duplicate.
The application for extension of time to pay (Part III) is:
Approved
Not approved because (see instructions for your appeal rights)
Other
Internal Revenue Service official
Address
Date
Name (print)
Title (print)
Signature:
4768
Form
(Rev. 8-2012)

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